Annular Repair After Discectomy

[Gilbert P]

Not sure if this has a previous post But this may have prevent my recent re-herniation?

Annular Repair After Discectomy: Spine 2010 Jul epub The below was probably mentioned in an earlier posting, ORS 2009 Annual Meeting Abstracts?

PMID: 20683387
Spine (Phila Pa 1976). 2010 Jul 30. [Epub ahead of print]
(c) 2010

The Effect of a New Anular Repair After Discectomy in Intervertebral Disc Degeneration: An Experimental Study Using a Porcine Spine Model.

Chiang CJ, Cheng CK, Sun JS, Liao CJ, Wang YH, Tsuang YH.
From the *Department of Orthopaedic Surgery, Taipei City Hospital, Taipei, Taiwan; daggerInstitute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan; double daggerDepartment of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan; section signInstitute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; paragraph signBiomedical Engineering Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan; parallelDepartment of Nursing, College of Health Sciences, Yuanpei University, Taipei, Taiwan; and **Institute of Traditional Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.


Abstract
STUDY DESIGN.:
In vitro and in vivo studies to assess the effect of direct anular repair on subsequent degeneration of intervertebral discs (IVDs).

OBJECTIVE.:
To assess whether a new suturing method could provide sealing effect on IVD after discectomy, and influence degenerative process of IVD.

SUMMARY OF BACKGROUND DATA.:
Recurrent disc herniation and subsequent disc degeneration are major problems after discectomy. Anular repair can reduce the risk of recurrence, but its effect on disc degeneration needs more investigation.

METHODS.: A new suturing technique, the modified purse-string suture (MPSS), was designed for direct closure of anular incision. Intact motion segments of porcine lumbar spine were used to validate this technique in resisting disc pressure under mechanical loadings. A transverse slit incision was made in the anterior anulus of porcine cervical discs, with or without sealing of the anular defect by this suturing method. Magnetic resonance imaging grading was recorded before and after surgery. Anular healing was assessed histologically and gene expression of aggrecan, collagen type I, II, and matrix metalloproteinase-13 in nucleus pulposus were investigated.

RESULTS.:
1150.3 +/- 121.1 N simple suture avg.Failure.Force axial
2917.9 +/- 627.6 N MPSS avg.Failure.Force axial
~253% more

The average failure force of axial compression was 1150.3 +/- 121.1 N for a simple suture, and 2917.9 +/- 627.6 N for a MPSS. Cyclic loading test showed that the repaired discs succeeded against repeated compression forces. Magnetic resonance imaging and gross appearances showed lesser degenerative changes in repaired discs than in injured discs at each time period. In repaired discs, mRNA expression of aggrecan and type II collagen downregulated slightly with time, whereas it decreased rapidly and persistently in unrepaired discs. Histologic findings showed primary healing of outer anular tract in repaired discs.


CONCLUSION.:
In this pilot study, the MPSS can provide effectively sealing for damaged anulus to withstand stresses. Direct repair of anular incision by this suturing method does significantly slow down degenerative process within discs after discectomy.

Gil

[sportsnut3007]

Intereseting that it says it slows down degeneration. I know that it obviously help prevents re herniation. Just wish they would get to the good stuff ( stem cells-mesoblast)asap. I suspect they will go through clinical trials with flying colors, but we shall see i suppose. Again those insurance executives or drs who say "there is no evidence of this being effective" will most likely be the ones if needed flying to europe to get artificial discs, especially in the neck. I see very little risk in adrs in the neck as its an easier revision. It isnt like we are asking for them to approve some skin cream to make u look young lol this are major improvents over fusion.

[Carson]

Gilbert,

There are a couple companies providing annular repair systems. Interesting process. Looks good.

Take a look at the X-Close system by Annulex: http://www.anulex.com/anulex_technol...deo_xclose.htm

[Carson]

And the Inclose mesh system also by Anulex: http://www.anulex.com/anulex_technology/video1_e.htm

[Keano16]

Not sure if this is widely used?

Thermal annuloplasty after endoscopic discectomy looks much better in my eyes.

[Carson]

Neither method is widely used. The XClose system is in Phase IV of US clinical trial to end in 2011.